NSAIDS and non narctoics Flashcards Preview

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Flashcards in NSAIDS and non narctoics Deck (61):
1

3 functions of Anti- Inflamatories NSAIDs

1) analgesic
2) anti-inflamatory
3) Antipyretic

2

Pharmacokinetics of NSAIDs, where are they metabolized, how are they excreted

-food doesn't change availability
-get in synoviral fluid good for arthritis

-metabolized by liver

-excreted renaly

3

MOA of NSAIDS

they inhibit the cyclooxygenase enzyme (COX).
COX needed to make prostaglandins (PG)

4

What does COX make and why is this product needed?

1) makes PG- needed for maintinance of body

PG protect mucosal layer of stomach, regulate blood flow to the kidney & allow platelets to function

5

What activates COX 2?

-inflamtion

6

Do COX 2 inhibitors specificly only inhibit COX 2

no only a little more

7

What is the only COX 2 inhibitor ?

Celebrex

8

Most ADRs of NSAIDs are related to inhibiting which cox?

Cox 1

9

GI side effects of NSAID

1) increased gastric acid bc PGs is GI mucosa protective

2) Dyspepsia

3) Gastro Duodenal Ulcer

10

During what time period of treatment dose hepatotoxicity from NSAIDs occur?

first 6 weeks

11

What to monitor and how often when pt. is on NSAIDs

-serum transaminases measured every 2 weeks for long term treatment

12

Black Box warning on NSAIDs is for what?

- cardiovascular thrombotic events
- myocardial infarctions
-stroke

13

What do NSAIds cause you retain?

salt and fluid

14

How many points do NSAIDs raise ur BP?

8-10 pts

15

Angioedema

an unstable complement system which is activated by inhibition of prostaglandins

16

who do you avoid using NSAIDs in?

asthmatic pts w/ polyps

17

ASA Aspirin

-irreversibly inhibits COX enzymes, platelet effect last 10 days

18

nonacetylated salicylates

dont have any effect on platelets

19

Do NSAIDs increase or decrease serum creatinine?

increase bc decrease blood flow to kidney

20

when is there an absolute contraindication to NSAIDs?

Abnormal kidney function

21

CNS effects of NSAIDs

HA
aseptic meningitis

22

which NSAIDs are the ones known for causing HAs?

-indomethacin
- tolmetin

23

which NSAIDs are the ones known for causing aseptic meningitis?

ibprofin

24

Which drugs to NSAIDs decrease the effectivness of?

Diuretics
ACEI
ARBS
- can lead to hyperkalemia

25

PUD with SSRI and NSAIDs?

SSRI may lead to depletion of serotonin in platelets, which is thought to play an important role in hemostasis

26

Which drugs increase PUD bleeding with NSAIDs

clopidogrel
warfarin
hepatins
DONT DO IT

27

Aspirin and Nonacetylated Salicylates

Acetyl salicylic acid
Magnesium & choline salicylate ( Trilisate)
Magnesium salicylate ( Doan’s Pills)
Choline salicylate (Arthropan)
Sodium salicylate
Salicylsalicylate (Disalcid)

28

ASA

-rapidly absorbed
-0 order

29

ASA dosage for mild pain

325-600

30

ASA dose for arthritis

650

31

ASA dosage for antiplatelet effect, angina, MI, CABG

81

32

How much blood loss in lost every day if ASA routinely used?

teaspoon in stool

33

Hyperpnea with ASA

high respiratory rate -> resp. aslk
antidote: stomach irrigation, IV fluids, sodium bicarb

34

Nonacetylated salicylates

less effective than ASA
dont use for antiplatelet effect

35

COX 2 selective NSAIDS

Celecoxib (Celebrex)
Meloxicam (Mobic)

36

COX 2 selectives

-the idea there would be more anti-inflammatory effect and less effect on stomach

-more CVS events (MI, stroke). This is because they inhibit COX-2 mediated prostacyclin synthesis in vascular endothelium

not protective of kidney blood flow but seem to cause fewer GI problems & less bleeding

37

What theraputic effect do COX 2s have?

1) antipyretic
2) antiinflamatory
3) analgesic

38

Celecoxib (CELEBREX)

-Sulfa: can get a rash if allergic to sulfa

-Long-term use of celecoxib may cause an increased risk of serious adverse cardiovascular thrombotic events, MI, and stroke, which can be fatal.

39

3 main Nonselective NSAIDs and their dosages

-Diclofenac (Voltaren)- 50 mg and 75 mg twice a day
-Ibuprofen (Motrin, Advil) 800 3 day
-Naproxen (Naprosyn, Aleve) 550 twice a day

40

IM NSAID is called...

Ketorolac

41

Ketorolac-

-IM loading dose, then oral max 40 mg/day

-use 5 days or less

-dont use for inflamation

42

3 NSAIDs with long 1/2 life -- ONCE DAILY DOSING

Oxaprozin (Daypro)
Piroxicam (Feldene)
Nabumetone (Relafen)

43

tolmentin

not effective for gout

44

how long do you give an NSAID before you switch?

2 weeks

45

cases where you should avoid using NSAIDs

have CHF, renal failure, active peptic ulcer disease, uncontrolled HTN

46

Is it okay to combine 2 NSAIDs?

NO

47

NSAID in pts with hx of high BP

check BP before starting and every two weeks
if high stop or give more HTN meds

48

What do you use if PUD and over 70?

Celebrex w/ PPI, and Misoprostol

49

Aceominphen APAP

-oral or rectal
-onset in 30-60 min
less than 3 grams/day
metabolized by liver and is toxic

50

APAP annecdote

mucomyst

51

What are the theraputic properties of APA?

-analgesic and antipyretic
NOT ANTI INFLAMTORy

52

Adverse effects of APAP

dizziness, excitment, disorientation

53

APAP antidote is...

N-acetylcysteine

54

can you add APAP to NSAIDs?

yes

55

Neuropathic Pain Relievers

Gabapentin (Neurontin)
Pregabalin (Lyrica)
amitryptyline- migraine and diabetic neuropathy

56

Two topical Pain Relievers

- Methyl slicylate (wintergreen oil)
-Capsacin

lidocainpatch patch

lidocaine/Prilocaine EMLA cream

57

MOA capsacin

release substance P, continuously stimulates nerve (hurts at first), continuous nervestimulation deplets substance P, works best for neuropathic pain

58

lidocaine patch

you can cut it

59

mild pain

acetominophin

60

moderate pain

NSAID

61

visceral pain?

narcotics, start with schedule 4- tramadol